2022-2023 
                     Office of Student Financial Aid 
                     P.O. Box 9031 
                     Petersburg, VA  23806 
                                                                                         
                                                     APPLICATION FOR SCHOLARSHIPS 
                      
                     This  application  is  for  a  merit-based  scholarship  award  from  Virginia  State  University  only.    All  information 
                     provided must be current.  Students should complete the Free Application for Federal Student Aid (FAFSA).  The 
                     student must have a cumulative GPA of 3.00 and be enrolled full-time to receive this University scholarship. (All 
                     new students receive merit scholarship(s) through our Admissions Office and are not eligible for the University 
                     Scholarship.)  Incomplete applications will not be processed. Deadline to submit Merit-Based Scholarship 
                     Application is April 30, 2022. 
                      
                     Scholarship Type:   ฀  University          ฀ Other____________________________________ 
                      
                     Name: _______________________________ SS # (Last 4 Digits): __________ V#________________ 
                      
                     Local Address: _______________________________________________________________________ 
                      
                     Permanent Address: ____________________________________________________________________ 
                      
                     Email address: _____________________________ Local or Cell Phone #: ________________________ 
                      
                     Date of Birth (Month/Day/Year):___________________            Sex:     ฀  Male                ฀  Female 
                      
                     Citizenship   ฀ U.S.      ฀Alien Registration # _________________                                                                       
                                        ฀ Other __________________ 
                      
                     Indicate your enrollment status:  ฀   Full-time (12 hrs. or more)      ฀    Part-time (11 hrs. or less)  
                      
                     Classification:    ฀  Freshman    ฀   Sophomore      ฀  Junior     ฀ Senior 
                      
                      
                     Major: _________________________________   Department: ________________________________ 
                      
                      
                     Provide a Departmental Reference:  
                      
                     Name _____________________ Department ______________________ Telephone #_______________ 
                      
                     I understand that submitting this application does not guarantee a scholarship.  Receiving this scholarship is 
                     contingent on funding availability.  I certify that the information provided is true. 
                      
                     _____________________________________________________________________________________ 
                     Signature        Date 
                             
                     For Office Use Only 
                                      2022-2023 Award Period                                                     Academics 
                       Budget_____________________                                  Cum GPA  ___________   
                                                                                     
                       Award_____________________                                   Major________________________________ 
                                                                                     
                       Remaining Need_____________                                  Classification _________________________ 
                                                                                     
                       EFC # ___________ PELL AWARD _________                       Reviewed By: _______________   Date: _____________